CONTRACT FOR PRIVATE MUSIC INSTRUCTION
|
|
- Ethan Douglas
- 7 years ago
- Views:
Transcription
1 CONTRACT FOR PRIVATE MUSIC INSTRUCTION I. GENERAL CONDITIONS i. Lessons will be offered over the academic year in each of the instruments for which the student is registered. Students will be scheduled and notified of recurring lesson date and time after registration. II. ATTENDANCE AND TARDIES i. The student and parent understand and agree that lessons must run on schedule in order to not interrupt the flow of other lessons scheduled with the same teacher or in the same room. If a lesson is missed for a legitimate reason, student agrees to arrange the make-up lesson at a time that may not necessarily be the regularly-scheduled time. If for a legitimate reason the lesson cannot start on time, the lesson will not be cancelled for a period of up to the first 10 minutes. If the lesson does not materialize within the first 10 minutes, all parties agree to treat the tardy as a missed lesson and agree to arrange a make-up lesson. i Missed lessons may be made up at another time, but no refunds will be granted. Parents agree to notify the conservatory office any time they remove a student from campus after they have checked in. III. GENERAL RULES AND PROCEDURES i. All students MUST check in at the Conservatory office for attendance purposes upon arrival for each lesson. It is the responsibility of the student to check-in and keep the conservatory informed of whereabouts at all times. i iv. The Conservatory reserves the right to reassign a private music lesson student to a different instructor if necessary. Parents agree not to interfere with lessons by refraining from attending lessons within the same room with the teachers and students, calling out to students in rooms or interrupting teachers in rooms while lessons are taking place. Parents agree to remain courteous at all times and direct concerns or complaints to the director and not to teachers, other students, other parents or any other concerned personnel. IV. REGISTRATION AND PAYMENT i. A non-refundable payment totaling the first full month s lessons is required at the time of registration to secure a slot in the appropriate studio. Early payments may be made if the parent wishes to do so. All lessons are billed and charged monthly, in advance by credit card. The parent or party responsible for the payment of the lessons agrees to a recurring charge of $ per lesson. Each payment made is for a lesson totaling minutes in duration. Parties agree that certain months will call for 5 lessons to be charged instead of 4.
2 V. TERMINATION OR WITHDRAWAL i. The student may request to be released from this contract for Private Music Instruction but must provide a minimum of two (2) week s notice. In the event that notice is not given and the student does not appear for lessons, the conservatory will hold that student s place for a two-week period and the lessons will be charged as if they occurred but without the benefit of a make-up requirement on the part of the Conservatory. After two weeks of un-notified absences, the conservatory will terminate this contract and no further lessons will be charged. NO REFUNDS WILL BE ALLOWED FOR UN-NOTIFIED MISSED LESSONS. The Conservatory reserves the right to terminate a student s participation for reasons including, but not limited to, poor behavior, theft or vandalism, use of inappropriate language, defiance or disrespect, fighting or any other behavior or action deemed by the Conservatory director to justify removal. Agreement I have read, received a copy of, and agree to be bound by the terms and conditions of this contract for private music instruction through the Arts & Minds Music Conservatory. I fully understand that Arts & Minds Conservatory is an independent agent and that failure to abide by this contract will result in termination of this agreement and membership in the conservatory will be revoked immediately. Parent Student
3 STUDENT REGISTRATION Student Name Address DOB Instrument City Zip School Currently Attending Grade Are there any siblings in the conservatory? [ ] Yes [ ] No PARENT INFORMATION Name Address Relationship City Zip Legal Guardian? [ ] Yes [ ] No Home Phone Cell Phone Work Phone BILLING INFORMATION AND AUTHORIZATION Name Exactly On Credit Card Credit Card Type: VISA MASTER CARD DISCOVER No: Expiration : 3 Digit Code: Lesson Selection (please initial one only):.5 Private 1.0 Private Group/Elementary $35.00 Per Lesson $50.00 Per Lesson $25.00 Per Session Please Note: Lessons are billed once per month on the 28 th day of each month. Depending on the day of week assigned, certain months will be billed for five lessons. I hereby authorize Arts & Minds Conservatory of Music to charge the above credit card for the music lessons selected above. I understand that the Conservatory will be billing on a monthly basis and I agree to pay according to the terms of the creditor and the Contract For Private Music Instruction. Signature
4 EMERGENCY CONTACT INFORMATION Arts & Minds Music Conservatory Student Name Parent/Guardian Name In case of emergency, who should we contact? Contact 1: Cell Phone Relation Work Phone Contact 2: Cell Phone Relation Work Phone Physician: Phone Number Please note any allergies (including allergies to medicines) that we should be aware of in case of emergency: Please list any medications taken regularly or medical history of concern: Insurance Company Policy Number or Group Number Principal Insured
5 AUTHORIZATION FOR EMERGENCY TREATMENT I,, hereby certify that I am the legal parent or guardian of. In case of an emergency while I am absent, I hereby authorize medical treatment to be provided to my child by emergency services as necessary for their safety and well-being while under the supervision of the Arts & Minds Music Conservatory. Print Parent/Guardian Name Signature
6 HOLD HARMLESS AGREEMENT I,, Parent of fully understand that my child s participation in music lessons or field trips with the Arts & Minds Music Conservatory may expose him/her to unforeseen risk of personal injury, death or property damage. I hereby acknowledge that I am voluntarily allowing my child to participate in all events and agree to assume any such risks. I hereby release, discharge and agree not to sue Arts & Minds Music Conservatory for any injury, death or damage to or loss of personal property arising out of or in connection with my child s participation in any event from whatever cause, including the active or passive negligence of Arts & Minds Conservatory staff or any other participants of the Conservatory. In consideration for being permitted to participate in the Conservatory, I hereby agree, for my child, my heirs, administrators, executors and assigns, that I shall indemnify and hold harmless Arts & Minds Music Conservatory from any and all claims, demands, actions or suits arising out of or in connection with my child s participation in any of the conservatory s events. I give permission to authorize personnel to carry out such emergency diagnostic and therapeutic procedures as may be necessary for my child, and also permit such treatment procedures to be carried out at, and by the local hospital(s) for my child in the event of an emergency. I understand that any medical expenses will be billed directly to me or my insurance company. I agree to permit Conservatory staff, agents and other guests to take photographs and/or videotape during Conservatory events and field trips without further recourse. I understand that such photographic images, video, or audio recording of my child may be used for commercial and/or promotional purposes. Minor s Name Age PARENT/GUARDIAN CONSENT (required if participant is younger than 18 years of age) I HAVE CAREFULLY READ THIS RELEASE, HOLD HARMLESS, AGREEMENT NOT TO SUE AND PHOTOGRAPHY RELEASE, AND FULLY UNDERSTAND ITS CONTENTS. I am aware that it is a full release of all liability and I sign it freely. As parent or guardian of this minor, I grant permission for him/her to participate in all Arts & Minds Music Conservatory events or field trips. Parent/Legal Guardian Signature Print
GATEWAY DISCOVERY CAMP
GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.
More informationDate: Student s Name DOB / / Age!!! (First)!! (Middle)!! (Last) Preferred name. Student s School Grade Level Dismissal Time
Lafayette Theatre Academy Registration Form Date: Student s Name DOB / / Age!!! (First)!! (Middle)!! (Last) Preferred name Student s School Grade Level Dismissal Time Parent/Guardian/Account Holder s Information
More information2016 Bowdoin Summer Art Camp Registration
2016 Bowdoin Summer Art Camp Registration Hours and Location Bowdoin Summer Art Camp will run for four weeks from June 27 th through July 22 th. The times and length of each session vary. Please refer
More informationYouth Programs Registration Form Summer of Service (SOS) 2015
Youth Programs Registration Form Summer of Service (SOS) 2015 Participant s Information PHONE GENDER: FEMALE OF BIRTH SCHOOL GRADE IN FALL 2015 MALE ETHNIC BACKGROUND AFRICAN ASIAN INDIAN LATINO NATIVE
More informationInitial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC
Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development
More informationAquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms
Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds
More informationCHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING
CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate
More information2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
More informationYouth Camp Civic Center
Youth Camp Civic Center Household ID # Please circle the session(s) that your child(ren) will attend Session One June 8- June 12 Session Two June 15 June 19 Session Three June 22 June 26 Session Four June
More informationWELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)
Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation
More information3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com
2009/2010 Policy Agreement I have received a copy of the 2009/2010 studio policy and current class schedule. I agree to adhere to all studio policies as contained in this document and explained to me.
More informationWinter Camp 2015 Church Registration Instructions and Policies
Winter Camp 2015 Church Registration Instructions and Policies Registration Instructions: 1) Choose your weekend(s). Prayerfully consider which available weekend is the best for your church. Bring your
More informationSouderton Area. Internship Contract
Souderton Area S c h o o l D i s t r i c t Internship Contract Student Information Student s Name: Street Address: City: State: Zip: Home Phone: Cell Phone: Company Information Company Name: Location Address:
More informationCalifornia Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.
California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER
More information2016 Release and Waiver of Liability PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS!
2016 Release and Waiver of Liability PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS! This Release and Waiver of Liability (the Release ) is executed on this day of (month),
More informationBartow County C.E.R.T.
Dear Applicant, I would like to take this opportunity to thank you for your interest in the Community Emergency Response Team. The CERT Program is presented by the Bartow County Emergency Management Agency
More informationFUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT
FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT This contract is to be signed by both the participant (child) and his or her parent/guardian. This ensures that both the child and the adult understand
More informationApplication Summer Study - Pre-College New York Summer Study 2016
Application Summer Study - Pre-College New York Summer Study 2016 First Name Birth Date (Month/Day/Year) Address Last Name Male Female City State Zip/Country code Country Home Tel. E-mail Current School
More informationCONTRACT FOR PHOTOGRAPHIC SERVICES
Client Name: Date: CONTRACT FOR PHOTOGRAPHIC SERVICES It is understood that Velvet Lotus Photography (Photographer) is the exclusive, official photographer retained to perform photographic services requested
More informationCamp Waiver Packet. Student Signature: Date: - - Parent Signature: Date: - - (Parent s signature is required if the student is under the age of 18)
Camp Waiver Packet You should have completed the initial registration and payment process on our website at www.centennialaviationacademy.com prior to completing this packet. If you have not done so, please
More informationQuality Driver Education 202 Main Street Pendleton, Indiana 46064 765-425-2252. Contract & Registration
Quality Driver Education 202 Main Street Pendleton, Indiana 46064 765-425-2252 Contract & Registration Month of class: of application: Last Name: Male Female First Name: Middle Initial: Address: City:
More informationARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION
2015-2016 SEASON MEMBERSHIP APPLICATION MEMBER INFORMATION: BACK TAG # ISSUED: MEMBER NAME: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CEL #: E-MAIL ADDRESS: (Please send newsletter via: Mail E-Mail ) DATE
More informationChang Scholarship Student Information
Chang Scholarship Student Information The mission of the Davis Schools Orchestral Music Association (DSOMA) is to support music students and the music program in general. Our music teachers believe that
More informationBaylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program
Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program Please see the enclosed information and application for more information. The Baylor Autism Resource Center (BARC) Applied
More information2015 2016 Classes Begin Monday, August 17 th ** = NEW TIMES & CLASSES
2-5 yrs. - PRE - K Monday - 4:15-5:00 T/J - (Pre-K/2-5yrs) Monday - 6:15-7:00 - T/B - (Pre-K/2-5yrs) ** Tuesday - 10:30-11:15 - T/B - (2-5yrs) Wednesday - 10:30 11:15 Ballet/ACRO - (2-5yrs) ** Wednesday-
More informationINTERNATIONAL LEADERSHIP OF TEXAS
INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS
More information2016 Summer Camp Registration Form
2016 Summer Camp Registration Form 1 of 6 2016 Summer Camp Registration Form All forms can be found online: http://go.dtcc.edu/swcamps q New Camper q Returning Camper Office Use Only: Identification Number
More informationYOUTH MENTORING PROGRAM. Mentee Application (To Be Completed by the Parent/Guardian)
Personal Information YOUTH MENTORING PROGRAM Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father Other, specify: Street
More informationTHE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP
THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP 2011 SUMMER FASHION PROGRAM STUDENT APPLICATION CHECKLIST To apply for the Summer Fashion Program, please submit the required documents to The Center for Global
More informationMath + Leadership Camp at CSUSM Registration Forms
Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of
More informationJ-1 Summer Work/Travel Program Terms and Conditions Program Sponsor: American Pool Enterprises, Inc.
Last Name: First Name: J-1 Summer Work/Travel Program Terms and Conditions Program Sponsor: American Pool Enterprises, Inc. Please read this document very carefully, and make certain that you understand
More information2014 Fort Worth Regional Science and Engineering Fair, University of Texas at Arlington, RadioShack. Media Release Form
2014 Fort Worth Regional Science and Engineering Fair, University of Texas at Arlington, RadioShack Media Release Form I hereby consent to and authorize the use and reproduction by Fort Worth Regional
More informationPeachtree Academy Home-School Collaborative Admissions Process
Peachtree Academy Home-School Collaborative Admissions Process Step 1: Contact the Headmaster of Principal to discuss Home-School Collaborative course needs and expectations. Step 2: A parent/student interview
More informationWest Virginia University 2015 Forensic Science Summer Camp
Thank you for registering for the! This packet contains the following forms that must be completed and returned before the student will be allowed to attend camp: Participant Information Form Event Participant
More informationPROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be
Personal Information Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father other, specify: Street Address: City: State:
More information2015 Summer Fun Classes Keyboarding on the PC
2015 Summer Fun Classes Keyboarding on the PC All materials are included! Grades 4th 12th Three classes available CRN 95287 - June 15 - June 25 CRN 95288 - July 13 - July 23 Locate home row keys automatically
More informationVIVA! Peer Tutors 2012 Health Literacy Video Contest COPYRIGHT FORM
COPYRIGHT FORM Every entrant must complete and submit this form together with ALL OTHER FORMS. Please do not send separately. All forms must be received by March 19, 2012. Please complete this form and
More informationSOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET
SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET School / Team: Name: Address: City, State, Zip: Home Phone: Cell Phone: Email: (please circle your responses) Do you attend the above named
More informationVietnam Veteran Application*
FOR HONORAIR-KNOXVILLE USE ONLY Last Name Date Received / / Vietnam Veteran Application* HonorAir-Knoxville recognizes American veterans for your sacrifices and achievements by flying you to Washington,
More informationCAMP MSC SENSATIONAL SUMMER SCIENCE
CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day
More informationTexas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment
Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information
More informationOberlin Dance Intensive
Oberlin Dance Intensive July 6-11, 2014 For Ages 14-18 Early Registration Deadline: March 1, 2014 = $585 tuition Regular Registration Deadline: April 10, 2014 = $625 tuition Email completed registration
More informationCAMP MSC SENSATIONAL SUMMER SCIENCE
CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day
More information2015 Nature Explorers Registration Form (Rising 1st to 3rd graders)
Information 2015 Nature Explorers Registration Form (Rising 1st to 3rd graders) Camper Name: DOB: Parent/Guardian Name(s): Address: City: State: Zip: Home Cell Work Email: *If emergency contact is different
More informationFORREST COLLEGE CHILD CARE. Handbook
FORREST COLLEGE CHILD CARE Handbook MISSION STATEMENT We are privileged at Forrest College to provide free child care for the children of our fulltime students. It is our aim to provide a safe and structured
More informationREGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl
REGISTRATION FORMS Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Address: City: State: Zip Code: Child #1 Days of the
More informationPlease list below any medical conditions and/or allergies the DBA Faculty should be
2015-2016 Registration Form Name Of Child(ren): Date of Birth: Address Where Child Resides: Mailing Address (if different from above): Home Phone Number: Please check next to whom the child resides with:
More informationCRASH COURSE FOR SUCCESS AGREEMENT
CRASH COURSE FOR SUCCESS AGREEMENT This is a legally binding agreement between CRASH Entertainment LLC, ( CRASH ), and YOU, the attendee/participant of this CRASH Course for Success Event. NO PERSON MAY
More informationTREATMENT PLAN DOMAINS: For each goal, please complete each of the following domains:
Section 24 Provider Agency: Date of Individual Treatment Plan: DOB: Age: TREATMENT PLAN DOMAINS: For each goal, please complete each of the following domains: Describe what the child will do in observable
More informationSTUDENT ATTENDANCE. General Requirements
STUDENT ATTENDANCE General Requirements The New Hanover County Board of Education (Board) believes that regular and punctual attendance at school is imperative for educational success. Students are expected
More informationGUATEMALA SURGERY TRIP Youth Volunteer Information and Release Form
Team Name: Guatemala Surgery Travel Dates GUATEMALA SURGERY TRIP Youth Volunteer Information and Release Form Please complete this entire form, including the release and liability form and return immediately.
More informationSummer College & Career Exploration Camps Parental Consent Form
Summer College & Career Exploration Camps Parental Consent Form This form must be completed, signed and returned to TCC one week prior to the camp start date. Email the completed form to wfdinfo@tcc.edu
More informationRegistration Form Spots are limited and on a first come first serve basis
UT Houston Medical School s JAMP Symposium March 27 th or April 17 th, 2015 Registration Form Spots are limited and on a first come first serve basis Please Note: Registration is not complete until you
More informationCassidy s Cause Therapeutic Riding Academy 6075 Clinton Rd Paducah, KY 42001 270-554-4040
VOLUNTEER / INTERN APPLICATION 2014 Thank you for your interest in volunteering with Cassidy s Cause! Our volunteers are the backbone of our program and without them our riders could not ride. Please complete
More informationAddress: Street City State Zip Code Home Phone: E-mail Address:
SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First
More informationPolk County Sheriff's Office and Florida Sheriff s Association
and Student/Parent Instructions Thank you for your interest in the. Parents, to enroll your Teenager into the training, please contact the Polk County Sheriff s Office Central District Command Center (telephone
More informationBig House 2015. Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th
Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th Big House 2015 June 11-14 Bellville, TX Big House is a summer mission
More informationMEDWAY PUBLIC SCHOOLS Medway, MA. Acceptable Use Policy for School Network, Internet, and Equipment Grades 7-12
MEDWAY PUBLIC SCHOOLS Medway, MA Policy #21-A Acceptable Use Policy for School Network, Internet, and Equipment Grades 7-12 The District s goal in providing computer network technology and Internet access
More informationMember Code of Conduct
Registration Packet At the Best Buy Teen Tech Center, youth pursue their interests and use new technologies with help from other teens and adult mentors. Then, they can share their work with peers across
More informationThank you for your interest in volunteering at Trinitas Regional Medical Center.
Thank you for your interest in volunteering at Trinitas Regional Medical Center. Please be advised that each participant in the Trinitas Regional Medical Center Volunteer program must complete the following
More informationHARVARD UNIVERSITY. INTERNATIONAL INTERNSHIP OR OTHER PROGRAM CONDITIONS OF PARTICIPATION and ASSUMPTION OF RISK AND GENERAL RELEASE
HARVARD UNIVERSITY Harvard University Risk and Release Form INTERNATIONAL INTERNSHIP OR OTHER PROGRAM CONDITIONS OF PARTICIPATION and ASSUMPTION OF RISK AND GENERAL RELEASE THIS IS A RELEASE OF LEGAL RIGHTS
More informationGeorgia Tech North Ave. NW Atlanta Ga. 30332
Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways
More informationCHALLENGER WORLD TOURS (CWT)
CHALLENGER WORLD TOURS (CWT) TRAVELER REGISTRATION DOCUMENT & TERMS AND CONDITIONS Mail, Fax or Scan/Email To: Challenger World Tours Attn: Gareth Hughes 8263 Flint, Lenexa, KS 66214 USA Phone: 800 878
More information2016 Summer Art Camp Scholarship Application Parental Consent Form
QUINLAN VISUAL ARTS CENTER April 17, 2016 Georgia Schools Attn.: Art Instructors, Principals Re: 2016 Summer Art Camp Scholarship Application Parental Consent Form Dear School Art Instructor and School
More informationGuest Profile. Smart Start
1111 Bagby St. Houston, TX 77002 713-651-0075 hfitness@plusone.com Monday Thursday: 5:30AM 9:00PM Friday: 5:30AM 8:00PM Saturday: Closed Sunday: Closed Guest Profile Mr. Ms. First Name: Last Name: of Birth:
More informationThe Merritt Kids College Program - A Review
Parent s Name: Address: Email Address: Cell Phone: Emergency Contact Name: Registration Form Home Phone: Number: Child s Name: Grade: Age: School Name: Gender: Male: Female: T-Shirt Size: Small: { } Medium:
More informationTampa Bay Performing Arts Academy
Tampa Bay Performing Arts Academy Musical Theater Disney Cinderella KIDS Sound of Music Disney s Lion King JR Dance Tap Broadway Dance Adv. Jazz Jr Broadway Jazz & Tap Private Voice Broadway Classical
More informationSAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS
SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ) the undersigned student wish to participate in a study abroad Program offered by Saint Louis
More informationHornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823
Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male
More informationBe An Angel Fund, Inc. 2003 Aldine Bender Houston, Texas 77032 or Fax to : 281-219-7746 or Scan and email to : russ@beanangel.org
Page 1 of 9 It is our MISSION to improve the quality of life for children with multiple disabilities or profound deafness by providing adaptive equipment and select services to individuals and institutions
More informationREGISTRATION FORM. Registration Forms & $200 Deposit due -> October 9, 2016
Northwest University College of Business T H E I M P E R I A L C I T I E S Budapest, Vienna and Prague I N T E R N A T I O N A L B U S I N E S S T O U R M a y 9-1 9, 2 0 1 6 REGISTRATION FORM REGISTRATION
More informationYMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM
YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM Branch: North Brooklyn YMCA Camp Site: North Brooklyn Branch Camp Type: PARTICIPANT INFO Child s Name Age D.O.B. Gender Grade in September 2016 School
More informationLIABILITY RELEASE. Walk on Water Ministries 3330 Perkinson Lane Merritt Island, FL 32953 (321) 412-8057 Praisedancer.bryan426@gmail.
Walk on Water Ministries 3330 Perkinson Lane Merritt Island, FL 32953 (321) 412-8057 Praisedancer.bryan426@gmail.com LIABILITY RELEASE In consideration of being allowed to participate in horseback riding
More informationRelease of Liability. Printed Name of Participant:
Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy
More informationChild and Youth Group. Volunteer Waiver Form
Child and Youth Group Volunteer Waiver Form VOLUNTEER WAIVER WARNING OF RISK, WAIVER, RELEASE OF ALL CLAIMS AGREEMENT Please read this form carefully and be aware that, in participating, you will be waiving
More informationPersonal/Athletic Training Agreement
Personal/Athletic Training Agreement Standard Fitness Training ½ Hour Session Total Package Cost Price Per Session Expiration Terms Packages 10 Sessions $300 $30.00 Sessions expire 10 weeks 20 Sessions
More informationNEW STUDENT REGISTRATION
NEW STUDENT REGISTRATION High Performance: Academy Prep: Early Childhood: $20.00 registration fee (includes 2 Academy T-shirts) $20.00 registration fee (includes 2 Academy T-shirts) $10.00 registration
More informationIn order to fully process your registration, you must complete this form in its entirety. Contact Information:
Page 1 of 6 In order to fully process your registration, you must complete this form in its entirety. Contact Information: Student Name: Grade in school 2013-2014: Date of Birth : / / Gender: School: Student
More informationCommunity House High School Programs Standing with families since 1969
Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster
More informationName: Period: Date: Foundations of Technology Mr. Báez Foundations of Technology Syllabus
Syllabus 1 Credit The course prepares students to understand and apply technological concepts and processes that are the cornerstone for the high school technology program. Group and individual activities
More informationAIRCRAFT RENTAL AGREEMENT
AIRCRAFT RENTAL AGREEMENT First Name: Last Name: Street Address: City: State: Zip: Home Phone: ( ) Cell Phone: ( ) Email: Date of Birth: / / Under Age 18 IN CASE OF EMERGENCY NOTIFY: Name: Telephone: Relationship:
More informationSummer 2013 Application Checklist
Summer 2013 Application Checklist \ Forms Camp Application Payment Form Authorization for Medication /Treatment Reminder Complete registration form Checks should be made payable to Camp Nova. We also accept
More informationClasses begin Monday, August 29 th, 2016 3-year-old class
Please return completed packets to the church office, along with a $25 registration fee. Checks can be made payable to First Christian Church, with Bright Beginnings in the memo. Classes begin Monday,
More informationUNIVERSITY OF HOUSTON
JAMES DICKEY'S UNIVERSITY OF HOUSTON 2014 MEN'S BASKETBALL CAMPS CAMP FEATURES Expert instruction from Houston Basketball staff and student-athletes Outstanding lectures Grouping of all players by ages
More informationCOMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM
COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM Child s Name (Last) (First) (Middle Init.) Address Apt. # Zip Code Home Telephone Message Telephone Birth Age *Gender: Male Female *Race (please
More informationRARITAN BAY AREA YMCA
Dear Applicant, Enclosed please find the Youth Leaders & Junior Counselor In Training Application and the Camp Registration Packet. Please complete the application and return all documents with your $100.00
More informationDepartment of Guidance and Counseling. Handbook. Homebound Procedures
A Developmental Guidance System Department of Guidance and Counseling Handbook Homebound Procedures General Education Homebound Packet Contents Forms Homebound Services Procedures for General Education
More informationRegistration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015
Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015 TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN. Date of Program Please print in ink or type, and
More information(US citizens under 18 must apply for the ISP guardianship program) Agent? Yes No Agency Name: Agency Contact Person: Street: Country, Zip code :
Last Name (family name) INTERNATIONAL STUDENT PLACEMENTS COLLEGE PROGRAM APPLICATION Attach recent photo here (smiling) Birthdate: Age: Male Female Month / Day / Year (US citizens under 18 must apply for
More informationcamp rules/behavior agreement
camp rules/behavior agreement Lake Metroparks camps use assertive discipline techniques that are used to strengthen good behavior by the use of positive reinforcement such as verbal praise, smiles, awards,
More informationCamp Culinaire. Camp Dates June 22-24, 2016 12:30 5:30 p.m. each day
Camp Culinaire Camp Dates June 22-24, 2016 12:30 5:30 p.m. each day For more information contact Jessica Hoffman Email: jhoffman16@ivytech.edu or Phone: 317-921-4292 Ivy Tech Community College Central
More informationTRAVELING PHOTOGRAPHY WORKSHOP APPLICATION
Wide Angle Youth Media Presents: TRAVELING PHOTOGRAPHY WORKSHOP APPLICATION WHAT? A free, 4-hour workshop where students will... WHO? WHERE? WHEN? Learn photography skills Take creative self portraits
More informationPlease return the completed documentation and your payment to the University in one of the following ways:
International Office GPO Box 2100 Adelaide SA 5001 Tel: +61 8 201 2727 Fax: +61 8 201 3177 www.flinders.edu.au CRICOS Provider No. 00114A Dear Applicant I would like to congratulate you on your offer to
More informationDeGrasse Dance Studio Registration Packet
DeGrasse Dance Studio Registration Packet Page 1: Prices - your copy Page 2 : Registration & Tuition Payment Agreement Please fill out, sign, date & turn in Page 3 : Agreement continued your copy Page
More informationIRELAND STUDY ABROAD APPLICATION May 9 to 22, 2016
Page 1 of 7 Please retain this page for your records do NOT submit with the application IRELAND STUDY ABROAD APPLICATION May 9 to 22, 2016 GENERAL INSTRUCTIONS All students who have registered for the
More informationwithout a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City:
Please mail application to: Las Campanas Compadres, Inc. 15 Buckskin Circle Santa Fe, NM 87506 Fax: 505 820 2709 Las Campanas Compadres, Inc. Student Application Form Please be sure to sign the waiver
More informationENROLLMENT AGREEMENT Denver Integrative Massage School, Inc 1221 Galapago Street, Denver, CO 80204 (303) 623-3121
ENROLLMENT AGREEMENT Denver Integrative Massage School, Inc 1221 Galapago Street, Denver, CO 80204 (303) 623-3121 Approved and Regulated by the Colorado Department of Higher Education, Private Occupational
More informationEast Hartford YMCA 770 Main St. East Hartford, CT 06108. Dear YMCA Family,
s Dear YMCA Family, Thank you for choosing the East Hartford YMCA for your early childhood education needs. We are excited to welcome you and your family to our program! The Y s focus is on youth development,
More informationGLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR
GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical
More informationClient Name First Last. Address City State Zip. Home Number Mobile Number. Work Number Email. Name First Last. Address City State Zip
CLIENT INFORMATION FORM For Office Use Only Therapist _ CPT Diag Code Fee Start Client DOB _ Client Name First Last Address City State Zip Home Number Mobile Number Work Number Email Parent/Guardian Information:
More information